Most randomized studies on revascularization in stable coronary artery disease exclude left main coronary artery disease (LMCAD). One example of this was the ISCHEMIA study. However, the benefits of functional lesion assessment, as demonstrated in the FAME studies, highlight the importance of this tool in guiding decisions regarding revascularization. Nevertheless, the clinical outcomes of patients…
Lithotripsy in the Left Main Coronary Artery
A lesion ≥50% in the left main coronary artery (LMCA) is considered severe, according to various scientific societies, regardless of the presence of symptoms or ischemia, due to the extent of myocardium at risk. In such cases, revascularization is indicated. In many patients, lesions in this section of the coronary artery have severe calcification, which…
Proximal Optimization Technique in Unprotected LMCA
Proximal optimization technique (POT) has been recommended as a standard strategy in bifurcation lesions because it facilitates proper stent implantation and apposition in the proximal main vessel, according to the European Bifurcation Club. Percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (LMCA) has specific characteristics, and the long-term impact of this strategy…
Revascularization vs. Deferral of Physiologically Significant Lesions in the Left Main Coronary Artery
Most randomized studies on decision-making in coronary artery disease revascularization exclude left main coronary artery disease (LMCAD), as did the ISCHEMIA Study. On the other hand, the benefits of functionally assessing lesions, proven in studies such as FAME, emphasize the importance of this tool in guiding revascularization decisions. However, there is still little understanding of…
Long-Term Mortality in Non-Obstructive Lesions in the Left Main Coronary Artery
Left main coronary artery (LMCA) intervention with significant lesions on both coronary angiography and intravascular ultrasound (IVUS), either through angioplasty (PCI) or myocardial revascularization surgery (MRS), is directly related to a decrease in long-term adverse clinical events. However, the relationship between subclinical LMCA disease (preserved luminal diameters) and long-term mortality is still unknown. A retrospective…